Authors (including presenting author) :
Chan KY (1), Salim A (1), So MH (1), Wong SL (1), Chui ST (1).
Affiliation :
(1) Department of Surgery, Prince of Wales Hospital
Introduction :
According to the Hong Kong Cancer Registry in 2019, hepatocellular carcinoma (HCC) is the fifth commonest cancer and the third leading cancer death in Hong Kong. When patients are diagnosed HCC at advanced stage, intervention radiological procedures including trans-arterial chemoembolization (TACE), radiofrequency ablation (RFA) and microwave ablation (MWA) are used to treat and prolong survival. The turnover rate of the nursing and medical staff is significantly high currently, the treatment is variated according to doctor’s preference and practice. Missing prescriptions would be happened. Ward nurses consume time and have burden to check the treatment frequently. There is no clear clinical pathway provided for the above procedures, nurses may feel stress for caring patients. Therefore, a quality improvement program is designed for standardizing the clinical pathway for those procedures.
Objectives :
1. Promoting clinical competence and happiness to enhance the job satisfaction for the nursing staff
2. Enhancing patient’s safety by minimizing the variation of the practice
3. Improve quality of clinical decision and consistency of care
4. Decrease the span of hospitalization
5. Providing the continuity of patient care by standardizing the clinical pathway for the procedures
Methodology :
The discussion was held among HBP medical and nursing teams for developing the clinical pathway of TACE. The specialist and the specialty nurses have contributed their experiences on the pathway. An audit form including blood taking, medication, puncture site checking and follow up arrangement was designed to check the compliance before and after the TACE procedure performed. Pre and post questionnaires were distributed to nurses for evaluating the clinical competence and job satisfaction. A sharing session of the new pathway to nursing and medical staff was held before implementation. The clinical pathway was implemented from March to October 2021 in HBP ward.
Result & Outcome :
Total 42 TACE pre and post cases were recruited and the overall compliance rate was significantly increased from 68.60% to 95.59% while the staff competence and job satisfaction was sharply increased from 44.89% to 92.00%. The results were very encouraging. In view of good result, the workgroup members moved on the second phase on the implementation of clinical pathway of the RFA and MWA which was commenced in December 2021. The team spirit was greatly enhanced after the program. The HBP medical and nursing staff greatly appreciated the clinical pathway to ensure patient’s safety and we are all happy and satisfied at work with confidence and quality to meet the future challenges.
